It was Sunday night. My beloved wife of 54 years, Diane, and I were watching a documentary about traveling in canal boats in the UK. Just a simple, gentle program, the perfect end of the day for those of us who have passed seven decades of existence. I was mildly surprised when Diane announced that her Apple Watch had just notified her of a resting heart rate of 135 beats per minute. This was well out of range for a woman who barely breaks 100 on a 3 mile walk. Then she mentioned that her jaw was hurting. That hit me like an electric shock, and I immediately searched for heart attack symptoms in women.
I confirmed that she had two of the symptoms. Terror filled me at the thought of losing her. Immediately I called 911. We live in a suburb of a very large city, which in 20 years has transitioned from a tiny small town with few residents to a modern community of 200,000. The emergency services are state of the art, and within a few minutes paramedics were at the door. Working swiftly, while maintaining calm, they got her loaded into an ambulance and on the way to a nearby hospital.
I grabbed a jacket and jumped into the car to follow. My mind was racing as I suddenly realized the gravity of the vow I made “Until death do us part.” In that state I headed to the hospital on a route just north of the hospital, but in my frantic state, driving the route that is south of the hospital. I didn’t realize my error for a few minutes, and had to backtrack. Meanwhile my oldest son had already arrived, so by the time I got there I was prevented entry, as only one family member is allowed at a time. After a quick text message, we traded places.
Sitting in the Emergency Room, I started absorbing the situation. I had my phone, but the battery was low and I had no charger. I could charge it in the car, but that would mean leaving. Not an option. I texted my son, who was now joined by his wife and his two brothers. Everyone wanted news, but I had none to give. They discussed the phone situation, and our quick-thinking daughter-in-law (one of three of the best ever) found and purchased a charger at a nearby gas station. This is the convenience of living near a huge city.
An x-ray and cat scan were taken, and inspected by the cardiologist on call. She saw no blockages, and said it was definitely not a heart attack. The diagnosis was atrial fibrillation, commonly referred to as AFIB. Meanwhile IV operations had started with medications to get her heart rate under control.
An hour or so later a room was available and she was admitted to the hospital. As she was wheeled to the room, I followed, trying to remain calm. The room was nice, state of the art, with all of the latest technology. Only 5 years has elapsed since this hospital opened, and it’s owned by the largest heath care organization in the United States. A team of nurses quickly assembled to get her transferred to the bed in the room. Given the technology available, I was very surprised when it was revealed that the cable used to connect the myriad sensors attached to my wife was incompatible with the monitors in that room. The nurse replaced the cable and tossed the original one into the trash bin. I did not question this, as I did not want to do anything to slow down the process. But I’ve been involved with technology long enough to recognize something that would cost at least $50 at Best Buy. This is yet another reason why health care is so expensive.
At least an hour passed, with nurses coming and going, and me answering questions that had been asked and entered into a computer multiple times already. We settled in for the longest night we’ve had since the birth of our first son. All eyes were on the monitor, hoping for a reduction of the pulse rate. The numbers barely budged. Meanwhile the blood pressure had crept up into concerning territory, and additional medication was added to the IV to bring it down. Relentless stress had left both of us in a state of exhaustion, but sleep was impossible. In her case it was due to nurses frequently coming in to check, though when their help was needed to disconnect her from the monitor for bathroom visits, they were slow to arrive. In the past a nurse friend of ours had said that Sunday night is the worst time to go into a hospital, as weekend nurses work 12 hour shifts, and are in a state of exhaustion themselves. Of course we had no choice in the matter.
At least 7 hours elapsed from the time the IV medication was started, with very little reduction in the pulse rate. About 3am a nurse came in to give her a potassium pill, so large that it had to be cut in half for swallowing. This was to keep her electrolytes in balance. Half an hour later, as I was watching the monitor, something changed. The pulse rate went wild, jumping to high numbers, then falling, then raising again. Clearly something was happening. I was about to summon the nurse when it suddenly stabilized in the high 90s, which was a low for the night. Slowly it began counting down, settling in the mid 70s. This is normal for most people. Meanwhile the blood pressure was also beginning to fall, eventually settling on a normal value for a healthy person.
The IV meds were left in place, and a couple of hours later an additional potassium pill was administered. As the dawn broke, neither of us had slept more than a few minutes and we wanted desperately to go home. At the nursing shift change a new round of people came in. We’d been told that the doctor’s rounds began at 8am, and we were strongly discouraged not to self-discharge, as the doctor would want to see us. By 9am we had not seen a doctor, but someone from the business office had come in to collect a signature to confirm we were financially responsible.
Being in the start of a new shift, the nursing staff was much more cheery, and helpful. The first to greet us said that Diane had been scheduled to have a stress test that day. Given the night we had just endured, I was of the opinion that she had just had a stress test. We declined. In other respects, this particular nurse was the most helpful. She texted the cardiologist twice to advise her that we were ready to leave as soon as possible. We also got periodic updates on the expected arrival time of the cardiologist.
A patient care representative arrived to tell us all the services that the hospital could provide, most of which we had already used. She also said she would give us a discount card for a very expensive prescription for a blood thinner I’ll call E, should the cardiologist prescribe it. During AFIB blood flow is diminished, and it becomes possible for clots to form. Those can break loose and cause heart attack or stroke. Blood thinners diminish the risk, but can also lead to uncontrollable bleeding, so they must be carefully monitored.
By 11am we still had not seen the cardiologist, but an internal medicine doctor came in to advise us that the cardiologist was coming. At this point we just wanted out, and this doctor did have the power to discharge. She prepared the paperwork, and yet another nurse was dispatched to get Diane into a wheelchair and take her down to the pickup point. I sprinted for the car. As I was loading her the nurse said we needed to wait a bit, as the patient care representative had something for us. We waited for several minutes, and then she phoned me to say that we had, in fact, been prescribed the very expensive drug E. She emailed me a photo of the discount card, promising it would save us money. Then, mercifully, we were able to depart and return to the real world.
After a quick lunch, and desperately needed naps, we had our first coffee of the day. I went online to explore the side effects of the prescriptions and collect the lab results from her tests. This led to some interesting observations, starting with the metabolic panel. On arrival at the hospital her potassium level was 3.3. That’s below the minimum normal value of 3.6. On leaving it was 3.9, back to the lower end of normal. Potassium is a very important electrolyte relating to heart function. Low values can lead to atrial fibrillation. Shortly after being given potassium, the AFIB stopped. I’ve had no medical training, but I can’t help but think there is cause and effect in play here. This especially after several hours of drugs that did nothing at all to bring the rate down.
We got a text message advising that the prescriptions were ready, with the price of the E drug being over $700 for 60 tablets. I researched this particular drug, which is a blood thinner. Like nearly all prescription drugs, E has a long list of frightening side effects. More disturbing is that once you start taking that drug, there is no point where you can just stop. The literature has a warning the about dangers of stopping suddenly. It requires careful monitoring by a physician. Given that she had experienced exactly one AFIB incident in 77 years, and had been on blood thinner for the entire episode, this seemed like excessive intervention. I checked the discount coupon we’d been given and discovered it was for a free 30-day trial. I couldn’t help but compare this to criminal drug dealers offering the “first hit” for free, knowing that it would lead to addiction. We’ve decided to opt for a daily aspirin instead, which our regular doctor has agreed is sufficient.
In retrospect, I think we were caught up in what Dr. Peter Attia calls “Medicine 2.0”, made worse by going in through the Emergency Room. The entire focus was to get the AFIB under control, without any consideration as to why it happened in the first place. Medications were prescribed automatically, based on the condition. Like every other encounter with a medical professional that we’ve ever had, the question “What do you eat?” was never asked. Our own 8 year experience of eating a low carbohydrate, high protein and fat diet has massively improved our health. This is never considered by the current level of medicine. Everything is focused on treating symptoms, not causes.
Like many traumatic situations, we’ve learned from this. Accepting the fact that getting older may involve more such episodes, here are some things we’ve taken away from this event:
We need to have a “go bag” packed with the essentials in case we need to make another unexpected exit. It must include a phone charger and cable.
We need to adjust our supplements to correspond with the seasons. In this case, lack of fruit during the winter months led to low potassium levels.
Paramedics are amazing. They are well trained. Their focus is on the patient they were called for. On arrival at the hospital, there are many patients also waiting for care, so waiting is inevitable. In our case, the paramedics stayed with her until she was seen.
With lots of research, proper diet, and exercise, we have gotten ourselves to peak health. This has caused us to lose sight of the fact that our bodies are getting older, and some parts really do fail. We all hope our passing will be in our sleep in our own bed. I realize now that we may well go to hospital again and only one of us may return.
Our twice-annual checkups by our primary care doctor are about to be joined by a visit to a cardiologist. This may also become a regular event.
It’s now been 3 days since we got back to our normal routine. The combined stress of the event, as well as being without sleep for more than 30 hours, have left us in an unfamiliar state. Muscles and joints have twinges that weren’t there before. We tire earlier than before. Our daily 3+ mile walk, which was achieved with ease on the morning preceding the event, has been slow to return. The first day we were too tired. Day two was just over a mile, and today a bit more than two miles. I know we’ll be back in the groove soon, but it’s clear that age is a factor in recovery time.
After 54 years of marriage, most people would probably say we are “joined at the hip”. The shock of this event has brought us even closer together. We’re more focused on getting the most out of each day together, so grateful that we can.
I'm so glad this all turned out as well as it did but it surely is a cautionary tail for the rest of us. Thanks for sharing this harrowing experience.
So glad that this story had a happy ending Jim! It must have been very scary though.